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Background: Successful management for functional neurological disorder (FND) requires multidisciplinary involvement starting with providing a definitive diagnosis. Objectives: To observe clinical management of patients with FND during hospital admission. Methods: A prospective observational study was conducted over six Australian hospitals over a 4‐month period. Data collected included patient demographics, communication of the diagnosis of FND, access to the multidisciplinary team, hospital length of stay (LOS), and emergency department (ED) presentations. Results: A total of 113 patients were included. Median LOS was 6 (interquartile range, 3–14) days. Thirty‐five (31%) presented to ED with 9 (8%) re‐presenting two or more times after hospital discharge. Total hospital utilization cost was AUD$3.5million. A new diagnosis was made in 82 (73%) patients. Inpatient referrals were made to neurology (81, 72%), psychology (29, 26%), psychiatry (27, 24%), and physiotherapy (100, 88%). Forty‐four (54%) were not told of the diagnosis. Twenty (24%) did not have their diagnosis documented in their medical record. Of the 19 (23%) not reviewed by neurology on non‐neurosciences wards, 17 (89%) did not have their diagnosis communicated and 11 (58%) did not have it documented. Twenty‐five (42%) referred to neurology were not provided with a diagnosis. Conclusions: Current gaps in service provision during inpatient hospital admissions in Australia include low rates of communication of a diagnosis, particularly when patients are not located on a neurosciences ward, and limited and variable access to inpatient multidisciplinary teams. Specialized services are needed to improve education, clinical pathways, communication, and health outcomes while reducing healthcare system costs. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine what factors make people with Parkinson's disease more susceptible to stereotype threat (i.e., the concern of being evaluated in line with negative group‐based stereotypes) and the clinical consequences of this. Method: Forty‐nine people with Parkinson's disease completed a measure of stereotype threat, as well as measures that indexed potential antecedents and clinical consequences of stereotype threat. Results: Younger age and greater communication difficulties emerged as significant predictors of stereotype threat. Higher stereotype threat was also associated with increased emotional distress. Conclusions: These findings are an important first step in understanding stereotype threat in Parkinson's disease and may help to guide the development of intervention and educational efforts aimed at countering its effects. [ABSTRACT FROM AUTHOR]

• Video-electroencephalography can help differentiate epileptic from nonepileptic seizures. • Patients with presumed epilepsy often actually suffer from nonepileptic seizures. • Long delays in the diagnosis of psychogenic nonepileptic seizures are common. • Correctly diagnosing nonepileptic seizures aids in providing appropriate care. Video-electroencephalography (VEEG) is an invaluable tool for the differentiation of psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES). This paper (i) evaluates the demographics of patients undergoing VEEGs at the Princess Alexandra Hospital from July 1 2017 to July 1 2019 and identifies those subsequently diagnosed with PNES, (ii) determines the delay in PNES diagnosis and proportion of PNES patients on antiepileptic drugs (AEDs) prior to a VEEG, and (iii) determines the proportion of PNES patients who subsequently ceased their AEDs. Of the 94 patients in the study group, 51 were female and 43 were male. In total, 22 (23%) of VEEGs were consistent with epilepsy (ES), 25 (26%), with PNES, 5 (5%) mixed (PNES and ES), 5 (5%) with other types of events, and 37 were nondiagnostic. Two patients with non-diagnostic VEEGs were subsequently treated as PNES at the treating clinician's discretion. Regarding AEDs, 62 of the patients were on at least one agent at the time of VEEG recording. The mean durations of AED therapy and diagnostic delay for patients subsequently diagnosed with PNES were six years and seven years, respectively. Of these, the majority had their AEDs subsequently weaned/ceased. This study highlights the value of VEEG in diagnostic differentiation of epileptic from nonepileptic events, thereby preventing unnecessary AED therapy for patients with PNES. The results are consistent with previous studies in the literature evaluating VEEG clinical outcomes. [ABSTRACT FROM AUTHOR]

Background and Purpose: There has been a concerted move in recent times to shift from an exclusionary to a positive diagnosis of functional movement disorders (FMDs). To date, most of the focus has been on defining positive physical signs. Here the focus was on the diagnostic specificity of specific symptoms and patient characteristics., Methods: For this prospective cohort study, newly referred patients in the Netherlands and Australia were recruited before their first neurology appointment. Participants completed questionnaires within 2 months prior to their visit at one of the six different clinics. Directly following the first consultation, physicians received a questionnaire about their diagnostic process. Patients were excluded if the diagnosis was not a movement disorder. Univariate and multivariate regression analyses were conducted to identify predictors of FMDs. Subsequently, a predictive model was constructed and assessed using the area under the receiver operating curve., Results: Between 1 March 2021 and 1 March 2023, 465 patients were eligible for inclusion, of whom 171 (37%) had an FMD and 294 (63%) a non-FMD. Distinguishing factors amongst these groups included age at onset, gender, history or family history of a functional and psychiatric disorder, sudden onset, specific triggers, fluctuation patterns throughout the day and over an extended period, pain, fatigue, depression, anxiety and dissociation. Using these, a predictive model was developed, yielding a discriminative accuracy of 88%., Conclusion: Specific symptoms and patient characteristics have high diagnostic discriminative value between FMDs and non-FMDs, providing an additional tool in positive diagnosis., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Objectives of this study were to identify the knowledge and support needs for a wide range of health professions who come in contact with patients with Functional Neurological Disorders (FND) in Australia. Invitations to an anonymous online survey (36 items) were sent to health professionals (practicing in the fields of neurology, psychiatry, psychology, general practice, nursing and physiotherapy) who are involved in the care of patients suffering from FND. Potential participants were invited via professional and hospital databases, advertising in professional newsletters as well as direct emails. A total of 538 health professionals completed the questionnaire. Most participants did not feel well educated about FND with only 14% of General practitioners (GPs) reporting 'good' knowledge. Neurologists, GPs and nurses reported lower clinical interest and greater negative attitude towards FND than psychiatrists, psychologists and physiotherapists. Many health professionals do not feel confident discussing the possibility of a Functional Neurological Disorder with a patient. Seeing more patients per year was significantly correlated with greater knowledge (r = 0.54) and confidence diagnosing (r = 0.49) FND. It was also significantly related to confidence in discussing the diagnosis of FND with a patient (r = 0.44). These factors were not significantly related to years of practice. Although patients suffering from Functional Neurological Disorders are commonly seen by many health professionals in clinic practice, there is little training in this area and self-perceived knowledge in Australia is generally poor. There is, however, clear interest in this area and our findings suggest that improved teaching and education of health professionals about FND and its management could potentially have a significant impact towards better patient care., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)